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Freda PU, Bruce JN, Jin Z, Kostadinov J, Khandji AG, Cremers S, Post KD. Prospective, Longitudinal Study of Cancer Predictors and Rates in a New York City Cohort of 598 Patients With Acromegaly. J Clin Endocrinol Metab 2025; 110:1247-1257. [PMID: 38986012 DOI: 10.1210/clinem/dgae469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/28/2024] [Accepted: 07/08/2024] [Indexed: 07/12/2024]
Abstract
CONTEXT Long-term growth hormone/insulin-like growth factor-1 (GH/IGF-1) excess could increase the risk of cancer in acromegaly, but individual levels of these hormones do not relate to this risk. OBJECTIVE We newly investigated longitudinally-measured IGF-1 levels as a potential predictor of cancer in a large New York City acromegaly cohort. METHODS We conducted a prospective, longitudinal study of 598 acromegaly (309 men, 289 women) and 292 clinically nonfunctioning pituitary adenoma (CNFPA) (140 women, 152 men) patients from the same underlying population. GH and IGF-1 levels were measured longitudinally and outcomes were observed during long-term follow-up. Cumulative exposure to IGF-1 excess was tested as a predictor of cancer. We compared cancer prevalence in acromegaly and CNFPA cohorts and incidence in each to that expected from Surveillance, Epidemiology, and End Results (SEER) data. RESULTS Cancer prevalence by last follow-up was 22.6% in acromegaly and 12.7% in CNFPAs (odds ratio [OR] = 1.99 [95% CI, 1.34-2.97]) (P = .0005). Overall standardized incidence ratio for cancer was 1.78 (1.51-1.81) in the acromegaly and 1.26 (0.89-1.70) in the CNFPA cohorts. Cumulative exposure to IGF-1 excess, OR = 1.278 (1.060-1.541) (P = .01), years from acromegaly diagnosis to cancer or last follow-up, OR = 1.03 (1.004-1.057) (P = .024), and age at follow up, OR = 1.064 (1.047-1.082) (P < .001), were predictors of cancer. CONCLUSION Cancer risk is increased in acromegaly, but not in CNFPA patients. Cumulative exposure to IGF-1 excess is a predictor of cancer in acromegaly. Our data suggest that cancer risk in acromegaly relates to the degree and duration of IGF-1 excess and that full appreciation of this risk requires long-term follow up.
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Affiliation(s)
- Pamela U Freda
- Departments of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| | - Jeffrey N Bruce
- Neurosurgery, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| | - Zhezhen Jin
- Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Jane Kostadinov
- Neurosurgery, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
- Department of Neurosurgery, Mt. Sinai School of Medicine, New York, NY 10029, USA
| | - Alexander G Khandji
- Radiology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| | - Serge Cremers
- Pathology and Cell Biology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| | - Kalmon D Post
- Department of Neurosurgery, Mt. Sinai School of Medicine, New York, NY 10029, USA
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Basu R, Boguszewski CL, Kopchick JJ. Growth Hormone Action as a Target in Cancer: Significance, Mechanisms, and Possible Therapies. Endocr Rev 2025; 46:224-280. [PMID: 39657053 DOI: 10.1210/endrev/bnae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 08/29/2024] [Accepted: 12/03/2024] [Indexed: 12/17/2024]
Abstract
Growth hormone (GH) is a pituitary-derived endocrine hormone required for normal postnatal growth and development. Hypo- or hypersecretion of endocrine GH results in 2 pathologic conditions, namely GH deficiency (GHD) and acromegaly. Additionally, GH is also produced in nonpituitary and tumoral tissues, where it acts rather as a cellular growth factor with an autocrine/paracrine mode of action. An increasingly persuasive and large body of evidence over the last 70 years concurs that GH action is implicit in escalating several cancer-associated events, locally and systemically. This pleiotropy of GH's effects is puzzling, but the association with cancer risk automatically raises a concern for patients with acromegaly and for individuals treated with GH. By careful assessment of the available knowledge on the fundamental concepts of cancer, suggestions from epidemiological and clinical studies, and the evidence from specific reports, in this review we aimed to help clarify the distinction of endocrine vs autocrine/paracrine GH in promoting cancer and to reconcile the discrepancies between experimental and clinical data. Along this discourse, we critically weigh the targetability of GH action in cancer-first by detailing the molecular mechanisms which posit GH as a critical node in tumor circuitry; and second, by enumerating the currently available therapeutic options targeting GH action. On the basis of our discussion, we infer that a targeted intervention on GH action in the appropriate patient population can benefit a sizable subset of current cancer prognoses.
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Affiliation(s)
- Reetobrata Basu
- Edison Biotechnology Institute, Ohio University, Athens, OH 45701, USA
- Department of Biomedical Sciences, Ohio University Heritage College of Osteopathic Medicine (OU-HCOM), Athens, OH 45701, USA
- Diabetes Institute, Ohio University Heritage College of Osteopathic Medicine (OU-HCOM), Athens, OH 45701, USA
| | - Cesar L Boguszewski
- SEMPR, Endocrine Division, Department of Internal Medicine, Federal University of Parana, Curitiba 80060-900, Brazil
| | - John J Kopchick
- Edison Biotechnology Institute, Ohio University, Athens, OH 45701, USA
- Department of Biomedical Sciences, Ohio University Heritage College of Osteopathic Medicine (OU-HCOM), Athens, OH 45701, USA
- Diabetes Institute, Ohio University Heritage College of Osteopathic Medicine (OU-HCOM), Athens, OH 45701, USA
- Molecular and Cellular Biology Program, Ohio University, Athens, OH 45701, USA
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Strzelec M, Kubicka E, Kuliczkowska-Płaksej J, Kolačkov K, Janek Ł, Bolanowski M, Jawiarczyk-Przybyłowska A. Copeptin and Mid-Regional Proadrenomedullin Are Not Useful Biomarkers of Cardiometabolic Disease in Patients with Acromegaly-A Preliminary Study. Biomedicines 2025; 13:666. [PMID: 40149642 PMCID: PMC11939899 DOI: 10.3390/biomedicines13030666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Revised: 02/19/2025] [Accepted: 02/28/2025] [Indexed: 03/29/2025] Open
Abstract
Background/Objectives: Cardiovascular complications are a leading cause of premature mortality in patients with acromegaly. Copeptin (CPP) correlates strongly with plasma osmolality and is regulated by non-osmotic stimuli involved in the pathophysiology of cardiovascular disease. Mid-regional proadrenomedullin (MR-proADM), synthesized mainly in the adrenal medulla, vascular endothelial cells, and the heart, has vasodilatory effects. The study aimed to assess two cardiovascular biomarkers (CPP and MR-proADM) in acromegaly patients in relation to disease activity and compare findings with a control group. Methods: The study examined CPP and MR-proADM levels alongside hormonal and biochemical parameters and cardiovascular and metabolic disease prevalence in 53 acromegaly patients and 26 controls. Results: No significant differences in CPP or MR-proADM concentrations were observed between the two groups. However, a positive correlation occurred between growth hormone (GH) and CPP concentrations, and there was a negative correlation between fasting glucose and CPP concentrations in acromegaly patients. The study also found a positive correlation between low-density lipoprotein (LDL) cholesterol and MR-proADM concentrations and between high-density lipoprotein (HDL) cholesterol and MR-proADM levels in the study group. Moreover, atherogenic dyslipidemia was significantly more common in the active form of acromegaly and pituitary macroadenoma patients than in the control group. Acromegaly patients had significantly higher fasting glucose and fasting insulin levels compared to controls, and the homeostasis model assessment of the insulin resistance (HOMA-IR) index was significantly lower in the study group than in the controls. Conclusions: Neither CPP or MR-proADM are significant diagnostic or monitoring indicators of cardiovascular or metabolic complications in acromegaly.
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Affiliation(s)
- Martyna Strzelec
- Department and Clinic of Endocrinology and Internal Medicine, Wroclaw Medical University, Wybrzeże Pasteura 4, 50-367 Wroclaw, Poland; (M.S.)
| | - Eliza Kubicka
- Department of Nuclear Medicine, Tadeusz Marciniak Lower Silesia Specialist Hospital-Centre for Medical Emergency, 54-049 Wroclaw, Poland
| | - Justyna Kuliczkowska-Płaksej
- Department and Clinic of Endocrinology and Internal Medicine, Wroclaw Medical University, Wybrzeże Pasteura 4, 50-367 Wroclaw, Poland; (M.S.)
| | - Katarzyna Kolačkov
- Department and Clinic of Endocrinology and Internal Medicine, Wroclaw Medical University, Wybrzeże Pasteura 4, 50-367 Wroclaw, Poland; (M.S.)
| | - Łucja Janek
- Statistical Analysis Centre, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Marek Bolanowski
- Department and Clinic of Endocrinology and Internal Medicine, Wroclaw Medical University, Wybrzeże Pasteura 4, 50-367 Wroclaw, Poland; (M.S.)
| | - Aleksandra Jawiarczyk-Przybyłowska
- Department and Clinic of Endocrinology and Internal Medicine, Wroclaw Medical University, Wybrzeże Pasteura 4, 50-367 Wroclaw, Poland; (M.S.)
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Rocha CPS, Hupalowski NN, Andrade VFC, Boguszewski CL, Borba VZC. Assessment of sarcopenic obesity in patients with acromegaly. Pituitary 2025; 28:25. [PMID: 39900878 DOI: 10.1007/s11102-024-01494-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/25/2024] [Indexed: 02/05/2025]
Abstract
PURPOSE Sarcopenic obesity (SO), a condition characterized by the coexistence of obesity and sarcopenia, has primarily been studied in elderly populations. However, it can also affect individuals with chronic diseases. This study aims to evaluate the prevalence of SO in patients with acromegaly. METHODS Observational, cross-sectional study, involving patients with acromegaly followed at a tertiary center and controls matched for age and sex. Health assessment questionnaire, physical tests, body composition and bone mineral density assessment, were performed in all participants. SO was diagnosed using criteria from ESPEN and EASO Consensus Statements. RESULTS 48 patients with acromegaly (acromegaly group - AG, 26 women, mean age 56.3 ± 11.6, mean BMI 31.3 ± 4.9) were compared to 48 controls (control group - CG, 26 women, mean age 56.7 ± 13.7, BMI 25.5 ± 4.7). Despite having greater total and appendicular lean mass, AG showed significant impairments in physical performance, particularly in strength, gait speed and balance (p < 0.05). The prevalence of SO in the AG was 16.7%, compared to 0% in the CG (p = 0.006), and positively correlated with increased fat mass and impaired physical performance. CONCLUSIONS SO is present in patients with acromegaly and is associated with notable functional impairments despite increased muscle mass.
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Affiliation(s)
| | - Natália Nachbar Hupalowski
- Endocrine Division (SEMPR), Department of Internal Medicine, Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | - Cesar Luiz Boguszewski
- Endocrine Division (SEMPR), Department of Internal Medicine, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Victória Zeghbi Cochenski Borba
- Endocrine Division (SEMPR), Department of Internal Medicine, Federal University of Paraná, Curitiba, Paraná, Brazil.
- SEMPR - Serviço de Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do Paraná, Avenida Agostinho Leão Jr, 285, 80030-110, Curitiba, Brazil.
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Górski K, Zgliczyński S, Stelmachowska-Banaś M, Czajka-Oraniec I, Zgliczyński W, Ciebiera M, Zgliczyńska M. Uterine fibroids in women diagnosed with acromegaly: a systematic review. Rev Endocr Metab Disord 2024; 25:773-781. [PMID: 38668933 PMCID: PMC11294406 DOI: 10.1007/s11154-024-09883-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 08/02/2024]
Abstract
The review discusses the relationship between acromegaly and uterine fibroids. It highlights variations in research methodologies and inconsistent findings, emphasizing the complex nature of fibroid development and the role of the somatotropic axis. Additionally, it addresses demographic factors and examines the potential impact of therapies on the risk and prevalence of uterine fibroids in individuals with acromegaly. We conducted an analysis of previously published literature that examined the repercussions of acromegaly on gynecological health in female cohorts, with specific attention directed towards elucidating the prevalence of uterine fibroids. We suggest that larger, more focused studies are needed to understand the specific impact of different treatments on the occurrence of gynecological issues in acromegaly patients. Additionally, our study emphasizes the importance of factors such as disease duration and treatment effectiveness. We hypothesize that a relationship between acromegaly and uterine fibroids may occur. However, it remains an area of ongoing research, with the need for larger, multi-center studies to draw more definitive conclusions.
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Affiliation(s)
- Konrad Górski
- Second Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland.
| | - Stanisław Zgliczyński
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Wojciech Zgliczyński
- Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Magdalena Zgliczyńska
- Department of Obstetrics, Perinatology and Neonatology, Centre of Postgraduate Medical Education, Warsaw, Poland
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Chen LH, Xie T, Lei Q, Gu YR, Sun CZ. A review of complex hormone regulation in thyroid cancer: novel insights beyond the hypothalamus-pituitary-thyroid axis. Front Endocrinol (Lausanne) 2024; 15:1419913. [PMID: 39104813 PMCID: PMC11298353 DOI: 10.3389/fendo.2024.1419913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/08/2024] [Indexed: 08/07/2024] Open
Abstract
Like the ovaries and prostate, the thyroid exhibits characteristic hormone secretion and regulation. Thyroid cancer (TC), especially differentiated thyroid carcinoma, has typical sex-specific and age-specific hormone-driven clinical features. Previous research has primarily focused on the effects of thyroid stimulating hormone, thyroid hormones, and estrogens on the onset and progression of TC, while the roles of growth hormone (GH), androgens, and glucocorticoids have largely been overlooked. Similarly, few studies have investigated the interactions between hormones and hormone systems. In fact, numerous studies of patients with acromegaly have shown that serum levels of GH and insulin-like growth factor-1 (IGF-1) may be associated with the onset and progression of TC, although the influences of age, sex, and other risk factors, such as obesity and stress, remain unclear. Sex hormones, the GH/IGF axis, and glucocorticoids are likely involved in the onset and progression of TC by regulating the tumor microenvironment and metabolism. The aim of this review was to clarify the roles of hormones and hormone systems in TC, especially papillary thyroid carcinoma, as references for further investigations.
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Affiliation(s)
| | | | | | | | - Chuan-zheng Sun
- Department of Head and Neck Surgery section II, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
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Falch CM, Godang K, Lekva T, Ueland T, Heck A, Bollerslev J, Olarescu NC. Long-term depot specific changes in adipose tissue after treatment of acromegaly. Eur J Endocrinol 2024; 190:K37-K42. [PMID: 38401530 DOI: 10.1093/ejendo/lvae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
CONTEXT Patients with active acromegaly present a decreased adipose tissue (AT) mass, and short-term studies show that treatment leads to AT depot-specific gain. However, it remains unclear if the increase is persistent in the long-term perspective and/or is sex-dependent. DESIGN To characterize the depot-specific changes of AT after treatment of acromegaly and identify contributing factors. METHODS Adipose tissue, including visceral (VAT), subcutaneous (SAT), and total (TAT), and android to gynoid ratio (A/G ratio) were measured by dual energy X-ray absorptiometry at diagnosis (n = 62), and after treatment at short-term (median (IQR) 1.9 (1.5-2.3)) and long-term 5.5 (3.9-9.5) years, and correlated to clinical and biochemical measurements. Growth hormone (GH), insulin-like growth factor 1 (IGF-1), glucose and HbA1c levels, gonadal status, and the presence of diabetes mellitus were recorded. Remission status was assessed at the long-term visit (IGF-1/ULN ≤ 1.3). Differences in the temporal course of AT from baseline to short- and long-term follow-up according to sex, diabetes, gonadal, and remission status were evaluated by mixed model analysis, adjusted for age. RESULTS Despite a stable body mass index, VAT and A/G ratio increased at both time points, whereas SAT mainly increased at short-term, plateauing afterwards (P < .05 for all). Visceral adipose tissue and A/G ratio were higher in men (P = .035 and P < .001), and the A/G ratio increased more than in women (P = .003). Glucose and HbA1c decreased short-term (P < .05) and remained stable at long-term. The increase in AT depots correlated with the decrease of disease activity at long-term. Remission status had no effect on changes in AT mass during follow-up. CONCLUSION Treatment of acromegaly leads to an increase in AT mass in a depot- and sex-specific manner both at short-term and long-term follow-up. Glucose metabolism improves rapidly after disease control and persists.
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Affiliation(s)
- Camilla M Falch
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital (OUS), PO Box 4950 - Nydalen, 0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo (UIO), PO Box 1171 - Blindern, 0318 Oslo, Norway
- Research Institute of Internal Medicine, OUS, PO Box 4950 - Nydalen, 0424 Oslo, Norway
| | - Kristin Godang
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital (OUS), PO Box 4950 - Nydalen, 0424 Oslo, Norway
| | - Tove Lekva
- Research Institute of Internal Medicine, OUS, PO Box 4950 - Nydalen, 0424 Oslo, Norway
| | - Thor Ueland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo (UIO), PO Box 1171 - Blindern, 0318 Oslo, Norway
- Research Institute of Internal Medicine, OUS, PO Box 4950 - Nydalen, 0424 Oslo, Norway
- Thrombosis Research Center (TREC), Division of Internal Medicine, University Hospital of North Norway, PO Box 6050 - Langes, 9037 Tromsø, Norway
| | - Ansgar Heck
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital (OUS), PO Box 4950 - Nydalen, 0424 Oslo, Norway
| | - Jens Bollerslev
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital (OUS), PO Box 4950 - Nydalen, 0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo (UIO), PO Box 1171 - Blindern, 0318 Oslo, Norway
| | - Nicoleta C Olarescu
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital (OUS), PO Box 4950 - Nydalen, 0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo (UIO), PO Box 1171 - Blindern, 0318 Oslo, Norway
- Research Institute of Internal Medicine, OUS, PO Box 4950 - Nydalen, 0424 Oslo, Norway
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Eroğlu İ, Iremli BG, Idilman IS, Yuce D, Lay I, Akata D, Erbas T. Nonalcoholic Fatty Liver Disease, Liver Fibrosis, and Utility of Noninvasive Scores in Patients With Acromegaly. J Clin Endocrinol Metab 2023; 109:e119-e129. [PMID: 37590020 PMCID: PMC10735300 DOI: 10.1210/clinem/dgad490] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/19/2023] [Accepted: 08/16/2023] [Indexed: 08/18/2023]
Abstract
CONTEXT Nonalcoholic fatty liver disease (NAFLD) is a metabolical disorder and can lead to liver fibrosis. Because it is commonly seen, several noninvasive scores (NS) have been validated to identify high-risk patients. Patients with NAFLD have been shown to have higher serum angiopoietin-like protein-8 (ANGPTL-8) levels. OBJECTIVE The risk of NAFLD is known insufficiently in acromegaly. Moreover, the utility of the NS and the link between NAFLD and ANGPTL-8 in acromegaly is unknown. METHODS Thirty-two patients with acromegaly (n = 15, active [AA] and n = 17, controlled acromegaly [CA]) and 19 healthy controls were included. Magnetic resonance imaging (MRI)-proton density fat fraction (PDFF) was used to evaluate hepatic steatosis, and magnetic resonance elastography to evaluate liver stiffness measurement. ANGPTL-8 levels were measured with ELISA. RESULTS Median liver MRI-PDFF and NAFLD prevalence in AA were lower than in CA (P = .026 and P < .001, respectively). Median magnetic resonance elastography-liver stiffness measurement were similar across groups. Of the NS, visceral adiposity index, fatty liver index, hepatic steatosis index, and triglyceride-glucose index (TyG) all showed positive correlation with the liver MRI-PDFF in the control group. However, only TyG significantly correlated with liver fat in the AA and CA groups. There was no correlation between traditional NAFLD risk factors (body mass index, waist circumference, C-reactive protein, homeostasis model assessment for insulin resistance, visceral adipose tissue) and liver MRI-PDFF in the AA and CA. Patients with acromegaly with NAFLD had lower GH, IGF-1, and ANGPTL-8 levels than in those without NAFLD (P = .025, P = .011, and P = .036, respectively). CONCLUSION Active acromegaly may protect from NAFLD because of high GH. In patients with acromegaly, NAFLD risk cannot be explained with classical risk factors; hence, additional risk factors must be identified. TyG is the best score to evaluate NAFLD risk. Lower ANGPTL-8 in patients with acromegaly and NAFLD implies this hormone may be raised because of insulin resistance rather than being a cause for NAFLD.
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Affiliation(s)
- İmdat Eroğlu
- Department of Internal Medicine, Hacettepe University, School of Medicine, 06230, Ankara, Turkey
| | - Burcin Gonul Iremli
- Department of Internal Medicine, Hacettepe University, School of Medicine, 06230, Ankara, Turkey
- Department of Endocrinology and Metabolism, Hacettepe University, School of Medicine, 06230, Ankara, Turkey
| | - Ilkay S Idilman
- Department of Radiology, Hacettepe University, School of Medicine, 06230, Ankara, Turkey
| | - Deniz Yuce
- Department of Preventive Oncology, Hacettepe University, School of Medicine, 06230, Ankara, Turkey
| | - Incilay Lay
- Department of Biochemistry, Hacettepe University, School of Medicine, 06230, Ankara, Turkey
| | - Deniz Akata
- Department of Radiology, Hacettepe University, School of Medicine, 06230, Ankara, Turkey
| | - Tomris Erbas
- Department of Internal Medicine, Hacettepe University, School of Medicine, 06230, Ankara, Turkey
- Department of Endocrinology and Metabolism, Hacettepe University, School of Medicine, 06230, Ankara, Turkey
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Jawiarczyk-Przybyłowska A, Kuliczkowska-Płaksej J, Kolačkov K, Zembska A, Halupczok-Żyła J, Rolla M, Miner M, Kałużny M, Bolanowski M. FTO Gene Polymorphisms and Their Roles in Acromegaly. Int J Mol Sci 2023; 24:10974. [PMID: 37446150 DOI: 10.3390/ijms241310974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/24/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
The major causes of both morbidity and mortality in patients with acromegaly are cardiovascular diseases (CVDs). The polymorphisms of the fat mass and obesity-associated gene (FTO) are associated with obesity, as well as with an increased risk of CVDs. The aim of the study was to determine the relationship of risk alleles of four FTO gene polymorphisms with selected parameters of lipid and glucose metabolism as well as with IGF-1 and GH levels in the group of patients with acromegaly compared to the control group. The study group consisted of 104 patients with acromegaly and 64 healthy subjects constituting the control group. In the whole acromegaly group, the data reveal that the homozygous for risk allele carriers (rs1421085, rs9930506, rs9939609) as well as carriers of only one risk allele have lower IGF-1 concentrations. In the well-controlled acromegaly group, the homozygous for three risk allele carriers of FTO gene polymorphisms have lower HDL cholesterol concentration (rs1121980, rs1421085, rs993609). In the cured acromegaly group, homozygous risk allele carriers rs9930506 tend to have higher levels of total cholesterol and LDL cholesterol. These associations are not observed in the control group. Conclusion: there is an association between FTO gene polymorphisms and the metabolism of lipids, suggesting that the FTO gene may be associated with higher CVD risk in patients with acromegaly. In addition, there is an association between FTO gene polymorphisms and IGF-1, implying that FTO gene may influence/modify IGF-1 synthesis. Further investigation on a larger scale is required to provide more precise evidence.
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Affiliation(s)
- Aleksandra Jawiarczyk-Przybyłowska
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, 50-367 Wrocław, Poland
| | - Justyna Kuliczkowska-Płaksej
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, 50-367 Wrocław, Poland
| | - Katarzyna Kolačkov
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, 50-367 Wrocław, Poland
| | - Agnieszka Zembska
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, 50-367 Wrocław, Poland
| | - Jowita Halupczok-Żyła
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, 50-367 Wrocław, Poland
| | - Małgorzata Rolla
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, 50-367 Wrocław, Poland
| | - Michał Miner
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, 50-367 Wrocław, Poland
| | - Marcin Kałużny
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, 50-367 Wrocław, Poland
| | - Marek Bolanowski
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, 50-367 Wrocław, Poland
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Khiyami A, Mehrotra N, Venugopal S, Mahmud H, Zenonos GA, Gardner PA, Fazeli PK. IGF-1 is positively associated with BMI in patients with acromegaly. Pituitary 2023:10.1007/s11102-023-01307-6. [PMID: 36930352 DOI: 10.1007/s11102-023-01307-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Acromegaly is a disorder characterized by IGF-1 excess due to autonomous GH secretion. In individuals without acromegaly, IGF-1 is not only influenced by GH secretion but is also sensitive to other factors including nutritional status, as evidenced by the inverted U-shaped association between BMI and IGF-1; in low-weight individuals (BMI < 18.5 kg/m2) and those who are obese, IGF-1 levels may be frankly low. It is not known if this same relationship between BMI and IGF-1 is also observed in acromegaly. METHODS Retrospective study including patients who underwent resection of a pituitary adenoma (n = 197) for either acromegaly (n = 32) or a nonfunctioning adenoma (NFPA, n = 165) at a large academic medical center between 1/1/2015 and 5/31/2021. RESULTS Median BMI in acromegaly was 30.8 kg/m2 (range 20.9-42.6 kg/m2). Percent upper limit of normal (%ULN) IGF-1 was 228.2% [159.0, 271.4] in acromegaly versus 32.2% [18.5, 50] in NFPA (p < 0.0001). There was a significant positive association between BMI and %ULN IGF-1 (R = 0.35, p < 0.05) in acromegaly. In contrast, there was no association between BMI and %ULN IGF-1 in the NFPA group as a whole (p = 0.22), but a significant inverse association between BMI and %ULN IGF-1 in NFPA patients with a BMI ≥ 35 kg/m2 (rho = - 0.39, p = 0.02). CONCLUSION In contrast to individuals without acromegaly, BMI is significantly and positively associated with IGF-1 in acromegaly across the weight spectrum. Future studies are needed to determine if obese patients with acromegaly experience more significant symptoms related to their disease, or if patients with a low BMI may require different diagnostic criteria.
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Affiliation(s)
- Anamil Khiyami
- Neuroendocrinology Unit, Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Clinical Medicine, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Neha Mehrotra
- Neuroendocrinology Unit, Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sharini Venugopal
- Neuroendocrinology Unit, Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hussain Mahmud
- Neuroendocrinology Unit, Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Georgios A Zenonos
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Pouneh K Fazeli
- Neuroendocrinology Unit, Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Kuker AP, Shen W, Jin Z, Chen J, Bruce JN, Freda PU. Long-term Outcome of Body Composition, Ectopic Lipid, and Insulin Resistance Changes With Surgical Treatment of Acromegaly. J Endocr Soc 2023; 7:bvad028. [PMID: 36922916 PMCID: PMC10008673 DOI: 10.1210/jendso/bvad028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Indexed: 02/25/2023] Open
Abstract
Context Acromegaly presents a unique pattern of lower adiposity and insulin resistance in active disease but reduction in insulin resistance despite a rise in adiposity after surgery. Depot-specific adipose tissue masses and ectopic lipid are important predictors of insulin resistance in other populations, but whether they are in acromegaly is unknown. Long-term persistence of body composition changes after surgery is unknown. Objective To determine how depot-specific body composition and ectopic lipid relate to insulin resistance in active acromegaly and whether their changes with surgery are sustained long-term. Methods Cross-sectional study in patients with active acromegaly and longitudinal study in newly diagnosed patients studied before and in long-term follow-up, 3 (1-8) years (median, range), after surgery. Seventy-one patients with active acromegaly studied cross-sectionally and 28 with newly diagnosed acromegaly studied longitudinally. Main outcome measures were visceral (VAT), subcutaneous (SAT), and intermuscular adipose tissue masses by whole-body magnetic resonance imaging; intrahepatic lipid (IHL) by proton magnetic resonance spectroscopy; insulin resistance measures derived from fasting; and oral glucose tolerance test insulin and glucose levels. Results SAT and insulin-like growth factor 1 level, but not VAT or IHL, were independent predictors of insulin resistance in active acromegaly. VAT, SAT, and IHL gains were sustained long-term after surgery. VAT mass rise with surgery correlated inversely with rise in QUICKI while SAT rise correlated with fall in the Homeostatic Model Assessment score. Conclusion SAT and disease activity are important predictors of insulin resistance in active acromegaly. Adiposity gains are sustained long-term after surgical treatment and impact on the accompanying improvement in insulin resistance.
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Affiliation(s)
- Adriana P Kuker
- Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| | - Wei Shen
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| | - Zhezhen Jin
- Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Jun Chen
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| | - Jeffrey N Bruce
- Department of Neurosurgery, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, 10032, USA
| | - Pamela U Freda
- Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
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Baumgartner C, Krššák M, Vila G, Krebs M, Wolf P. Ectopic lipid metabolism in anterior pituitary dysfunction. Front Endocrinol (Lausanne) 2023; 14:1075776. [PMID: 36860364 PMCID: PMC9968795 DOI: 10.3389/fendo.2023.1075776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
Over the past decades, adapted lifestyle and dietary habits in industrialized countries have led to a progress of obesity and associated metabolic disorders. Concomitant insulin resistance and derangements in lipid metabolism foster the deposition of excess lipids in organs and tissues with limited capacity of physiologic lipid storage. In organs pivotal for systemic metabolic homeostasis, this ectopic lipid content disturbs metabolic action, thereby promotes the progression of metabolic disease, and inherits a risk for cardiometabolic complications. Pituitary hormone syndromes are commonly associated with metabolic diseases. However, the impact on subcutaneous, visceral, and ectopic fat stores between disorders and their underlying hormonal axes is rather different, and the underlying pathophysiological pathways remain largely unknown. Pituitary disorders might influence ectopic lipid deposition indirectly by modulating lipid metabolism and insulin sensitivity, but also directly by organ specific hormonal effects on energy metabolism. In this review, we aim to I) provide information about the impact of pituitary disorders on ectopic fat stores, II) and to present up-to-date knowledge on potential pathophysiological mechanisms of hormone action in ectopic lipid metabolism.
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